Exploring the public health role in assessing impacts of coal export proposals in the Pacific Northwest

Due to changes in global energy markets, several proposals have emerged to export coal from the Powder River Basin of Wyoming and Montana through Pacific Northwest ports.  Debates over these proposals engage with an array of health issues, including climate change, economic development, environmental degradation, and exposure to toxins.  This presentation discusses the ways that public health stakeholders – government agencies, academics, community groups, and non-profit organizations – have participated in these ongoing debates, specifically related to assessing health impacts of the proposals.  Activists have called on public health agencies to weigh in on the proposals, yet few agencies have had the combination of political will, technical expertise, and staff time necessary to document potential impacts across the region. Instead, smaller local analyses have been conducted to assess very specific exposures and/or geographies; these include a report by the Multnomah County Health Department in Portland, Oregon and a multi-site assessment conducted in Washington State.  Despite broad interest in a health impact assessment (HIA) to inform policy decisions, no team coalesced to conduct the HIA.  The completed work represents an important foray into “health in all policies,” but also illuminates barriers to the approach.  While focusing on these local impacts of coal transportation has been an analytical and political necessity, it has precluded analysis of upstream aspects of the coal cycle, which are some of the most contentious aspects of the debate.  Assessment has been hamstrung by limitations of the existing public health system, namely the lack of health outcome data applicable to small geographic units and the disconnection between environmental regulation and health promotion agencies.  Further, this case study demonstrates the difficulty of implementing of a health in all policies approach to a regional problem that crosses a wide variety of jurisdictions and therefore multiple policy decisions.